Prognostic significance of tumor size for primary invasive cutaneous melanoma: A population-based study, 2004-2016
Prognostic significance of tumor size for primary invasive cutaneous melanoma: A population-based study, 2004-2016
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肿瘤大小对原发性侵袭性皮肤黑色素瘤的预后意义：一项基于人群的研究，2004-2016
DOI：
10.1002/cam4.3065
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发表时间：
2020-05-05
期刊：
影响因子：
4
通讯作者：
Tao, Juan
中科院分区：
文献类型：
--
作者：
Ma, Qiuying;Suo, Huinan;Tao, Juan
背景本研究旨在评估与原发性侵袭性皮肤黑色素瘤 (CM) 的其他临床和病理特征相比，肿瘤大小的独立预后价值。方法本研究纳入了 2004 年至 2016 年监测、流行病学和最终结果计划数据库中诊断的 28,593 名原发性侵袭性 CM 患者。肿瘤大小分为 5 个亚组（42 mm）。主要终点是黑色素瘤特异性生存率（MSS）。结果肿瘤大小与生存率之间的关系是分段的。调整年龄、性别、原发部位、组织病理学细胞类型、Breslow 厚度、溃疡、有丝分裂率、区域转移和远处转移后，MSS 的风险比 (HR) 随着肿瘤大小的增加而增加，直到 31-42 mm 处达到峰值（HR 分别为 1.33、1.59、2.41；所有 P < .0001），然后使用肿瘤大小当肿瘤大小大于 42 mm 时降低42 mm 亚组在 T4 中的 MSS 最短。此外，在 T1N0M0 原发性 CM 中，截断值为 12 mm 的肿瘤大小对 MSS 的预后价值（HR，2.32；95% CI，1.80-2.98；P < .0001）比 Breslow 厚度和有丝分裂率更强。 结论 肿瘤大小是原发性侵袭性 CM 患者 MSS 的重要独立预后因素。肿瘤尺寸大于 30 毫米将为局部 CM 的每个 T 亚类提供额外且重要的预后信息。此外，截止值为 12 mm 的肿瘤大小在提高黑色素瘤 T1 分期的准确性方面具有巨大潜力。
Background This study aimed to assess the independent prognostic value of tumor size compared with other clinical and pathologic features of primary invasive cutaneous melanoma (CM).Methods This study included 28,593 patients with primary invasive CM in Surveillance, Epidemiology, and End Results Program database diagnosed from 2004 through 2016. Tumor size was divided into five subgroups (42 mm). The primary endpoint was melanoma-specific survival (MSS).Results The relationship between tumor size and survival was piecewise. After adjusting for age, sex, primary site, histopathologic cell type, Breslow thickness, ulceration, mitotic rate, regional metastasis, and distant metastasis, the hazard ratio (HR) of MSS increased with increasing tumor size until a peak at 31-42 mm (HRs, 1.33, 1.59, 2.41, respectively; all P < .0001), and then decreased when tumor size was larger than 42 mm using tumor size 42 mm subgroup had the shortest MSS in T4. In addition, tumor size with a cutoff value of 12 mm showed stronger prognostic value for MSS (HR, 2.32; 95% CI, 1.80-2.98; P < .0001) than Breslow thickness and mitotic rate in primary CM with T1N0M0.Conclusions Tumor size was an important independent prognostic factor for MSS in patients with primary invasive CM. Tumor size larger than 30 mm would provide additional and important prognostic information in each T subcategory of localized CM. Furthermore, tumor size with a cutoff value of 12 mm has great potential in improving the accuracy of melanoma T1 substaging.